老年患者腹部手术后肺部感染防治的护理干预

目的探讨加强全面护理干预老年患者腹部手术后肺部感染的发生率。方法将该院收治的240例老年腹部手术患者随机分为观察组与对照组,对照组患者采用常规护理措施,观察组患者使用加强全方位护理干预,比较2组患者术后24h排痰量、肺部感染发生率、住院时间、护理满意度。结果观察组患者术后4d内24h排痰量[(22.63±5.66)、(33.41±8.36)、(34.25±8.57)、(34.72±8.69)mL]均显著高于对照组[(15.23±3.81)、(17.92±4.48)、(18.06±4.52)、(18.66±4.67)mL],观察组患者术后肺部感染发生率(2.50%)明显低于对照组(7.50%),住院时间[(11.74±3.05)d]短于对照组[(13.86±3.47)d],护理满意度(93.33%)高于对照组(78.33%),差异均有统计学意义(P0.05)。结论老年患者腹部手术实施全面护理干预,可促进术后早期排痰,有效降低肺部感染发生率,缩短住院时间,提高护理工作满意度,值得临床推广应用。     

全面护理干预对神经外科患者术后并发症的控制效果

目的 探讨全面护理干预对神经外科患者术后并发症的控制效果.方法 将90例神经外科手术患者随机分为两组,每组45例.两组均接受神经外科术后常规护理,研究组在此基础上联合全面护理干预.观察住院全程.干预后比较两组术后并发症发生状况、住院时间及患者满意度.结果 研究组肺部感染、误吸、低氧血症发生率显著低于对照组(P＜0.05),排痰不畅发生率虽低于对照组但差异无显著性(P＞0.05);研究组住院时间显著少于对照组(P＜0.01);研究组满意率为95.6％,对照组为77.8％,研究组显著高于对照组(P＜0.05).结论 全面护理干预能显著减少神经外科患者术后并发症的发生,缩短住院时间,提高患者满意度.     

集束化护理干预在老年患者腹部术后肺部感染预防中的应用

目的:探讨集束化护理干预在老年患者腹部术后肺部感染预防中的应用效果。方法:将80例老年开腹手术患者随机分为对照组和干预组各40例,对照组采用常规护理措施,干预组在常规护理基础上采用集束化护理干预。比较两组患者术后呼吸功能指标、术后首次下床时间、术后肺部感染发生率和患者对护理服务的满意度。结果:干预组患者咳嗽程度、痰液黏稠度、咳痰难度均优于对照组(P0.05);干预组患者首次下床时间早于对照组(P0.05);干预组患者肺部感染发生率低于对照组,患者对护理服务满意度高于对照组(P0.05)。结论:集束化护理干预能提高老年患者腹部术后呼吸功能,促进早期下床活动,降低肺部感染发生率,提高患者对护理服务的满意度。     

颈椎骨折合并颈髓损伤病人的排痰方案探讨

[目的]探讨颈椎骨折合并颈髓损伤病人的排痰方案。[方法]将54例颈椎骨折合并颈髓损伤病人分为观察组和对照组各27例,对照组采用常规的排痰方法,观察组采用综合序贯排痰法。护理2周后,比较两组病人的获得性肺炎和肺不张发生率、并发症的治愈时间、排痰后肺部听诊好转率。[结果]对照组病人获得性肺炎的发生率(53%)和肺不张发生率(17%)高于观察组病人的获得性肺炎发生率(11%)和肺不张发生率(7%),差异有统计学意义(P0.05);观察组病人的治愈时间(7.0d±1.7d)少于对照组病人(19.6d±3.4d),差异有统计学意义(P0.05);观察组病人的排痰后肺部听诊好转率(82%)高于对照组(50%),差异有统计学意义(P0.05)。[结论]复合序贯排痰法相对于传统方法并发症发生率低,治愈时间短,排痰效果明显的优点,更加适用于颈髓损伤病人的排痰护理。     

手术室护理干预对术后肺部感染发生率的影响

目的 探讨手术室护理干预对患者术后肺部感染发生率的影响.方法 选取2012年1-12月实施手术治疗患者90例为研究对象,随机分为观察组和对照组,各45例,观察组实施手术室护理干预,对照组患者实施常规护理干预,观察2组术后肺部感染发生率、住院相关指标和护理质量满意度差异.结果 观察组肺部感染率为6.7％(3/45)、住院时间(8.9±2.3)d,住院费用为(6654.5±215.4)元,均显著低于对照组的26.7％(12/45)、(15.2±5.1)d和(8526.5±167.6)d(P＜0.05或P＜0.01);观察组护理满意度95.6％(43/45),显著高于对照组的82.2％(37/45),差异具有统计学意义(P＜0.05).结论 手术室护理干预能有效降低术后肺部感染发生率,提高护理满意度,值得推广使用.     

整体护理干预对结核性脓胸术后肺部并发症的影响

目的观察整体护理干预对结核性脓胸外科手术后患者恢复情况及术后肺部并发症的影响。方法将145例结核性脓胸行开胸手术的住院患者按入院先后顺序分为干预组76例和对照组69例,对照组实施常规护理,干预组在常规护理的基础上实施整体护理干预,比较2组患者术后咳嗽、以及肺不张、胸腔积液、肺部感染等并发症的发生情况。结果干预组各项并发症发生率明显低于对照组,差异具有统计学意义(P0.05),干预组术后有效排痰优于对照组,差异有统计学意义(P0.05)。结论结核性脓胸术后实施整体护理干预可以促进患者有效排痰,减少术后并发症的发生,提高患者生活质量,值得临床推广。     

可必特联合沐舒坦术前雾化吸入在肺癌手术治疗中的应用效果

目的探讨术前雾化吸入可必特联合沐舒坦在肺癌手术治疗中的应用效果。方法将86例肺癌手术患者按随机数字表法分为2组：观察组43例于术前3 d至术后5 d行雾化吸入;对照组43例于术后5 d行雾化吸入。比较2组患者术后排痰不适及肺部并发症（肺不张、肺部感染和发热等）发生率,并记录胸腔闭式引流管拔管时间和术后吸氧时间。结果观察组术后排痰不适感及肺部并发症发生率均较对照组显著减少（P〈0.05）;观察组术后胸腔闭式引流管拔管时间及吸氧时间均较对照组显著缩短（P〈0.05）。结论术前雾化吸入可显著降低肺癌术后患者排痰不适感和术后肺部并发症发生率,缩短术后胸腔闭式引流管拔除时间及术后吸氧时间。     

改良叩背护理法对老年脑卒中患者肺部感染的防治效果观察

目的观察改良叩背护理法对老年脑卒中患者肺部感染的防治效果。方法将70例老年脑卒中患者按照随机数字表法分为两组,对照组(n=35例)采用传统叩背护理,观察组(n=35例)采用改良叩背护理。比较两组排痰前后血气指标、痰液黏稠程度、排痰量、肺部感染发生率、呼吸困难指数、住院时间及叩背舒适度。结果两组排痰后血气指标均明显改善(P0.05),且观察组PO_2、SaO_2血气指标改善程度更为显著(P0.05);观察组痰液黏稠程度、排痰量、肺部感染发生率、叩背舒适度、呼吸困难指数均明显优于对照组(P0.05)。结论改良叩背护理法可促进老年脑卒中患者痰液排出,降低肺部感染发生率,明显提高叩背舒适度。     

复合序贯排痰法在颈髓损伤患者中的应用

目的：探讨复合序贯排痰法在颈髓损伤( CSCI)患者中的排痰效果。方法选取2011年1月—2013年12月收治外伤性CSCI患者86例,按入院时间分为观察组和对照组,每组各43例。观察组采用复合序贯排痰法,对照组采用常规的护理措施排痰。评价两组患者肺部感染和肺不张发生情况及人工气道的使用情况。结果观察组肺部感染及肺不张发生率为9.3%,对照组为37.2%,两组比较差异有统计学意义(χ2=9.382,P<0.05);观察组治愈时间低于对照组,差异有统计学意义(t=-6.339, P<0.05)。观察组人工气道使用率为7.0%,对照组为30.2%,两组比较差异有统计学意义(χ2=7.679, P<0.05);观察组使用人工气道患者的带管时间低于对照组,差异有统计学意义(t =-5.490,P <0.05)。结论复合序贯排痰法可有效促进CSCI患者痰液排出,降低肺部感染和肺不张的发生率,提高其治愈率,降低人工气道使用率并缩短平均带管时间。     

振动排痰法对外科术后ICU机械通气患者排痰效果的影响

目的探讨振动排痰法对外科术后ICU机械通气患者排痰效果的影响。方法将本科室收治的80例外科术后ICU机械通气随机分为观察组40例和对照组40例,对照组采用人工排痰法,观察组采用机械振动排痰法,比较2组的排痰效果、护理2 d后的血气指标、肺部感染率以及ICU停留时间。结果观察组术后2 d的排痰量均多于对照组,痰液粘稠程度好于对照组,差异有统计学意义(P0.05)。观察组护理2 d时的Sa O_2、p(O_2)大于对照组,p(CO_2)小于对照组,肺部感染的发生率低于对照组,住ICU的时间短于对照组,差异均有统计学意义(P0.05)。结论机械振动排痰能够显著提高ICU患者的排痰效果,改善肺部通气,减少肺部感染,缩短ICU住院时间。     

Endovascular treatment for chronic pulmonary hypertension: a focus on angioplasty for chronic thromboembolic pulmonary hypertension

Introduction: Percutaneous transluminal pulmonary angioplasty (PTPA) was introduced for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) in the late 20^th century, and first attempts in collective patients were made in 2001 with beneficial effects but a moderate amount of complications. It was refined around 2010, and has been recently established as an effective and safe treatment.

Areas covered: The indication was originally inoperable CTEPH with peripheral lesions, but has now widened to symptomatic or hypoxic patients. The lesion is typically a meshwork-like structure of organized thrombi and is sometimes not seen as a stenosis angiographically, necessitating other means of investigation such as measurement of distal pressure. The technique to treat lesions is the same as for coronary angioplasty except in several ways.

Expert commentary: The effects of PTPA are comparable to those of surgical endarterectomy, and the complications of reperfusion pulmonary edema and vascular injury are now controlled by several strategies and based on experience.     

肺转移瘤的外科治疗

目的 :探讨肺转移性肿瘤外科治疗的手术指征、手术方式、手术疗效。方法 :对 36例肺转移性肿瘤的相关临床资料进行回顾性分析。结果 :对 36例肺转移性肿瘤行肺切除术 39次 ,随访 1年～ 15年 ,术后 1年、3年、5年、10年生存率分别为 77.8%、48.2 %、2 1.7%、7.7%。无手术死亡。结论 :对原发肿瘤已控制、肺转移瘤可以切除、无他处转移及肺功能可承受手术者作为手术指征     

Transthoracic Echocardiographic Evaluation of Pulmonary Valve Anomalies in Pediatric Patients

The pulmonary valve normally consists of 3 leaflets supported in a semilunar fashion within the sinuses of the pulmonary trunk. Pulmonary leaflet malformations, such as congenital single pulmonary cusp absence, bicuspid pulmonary valve, and quadricuspid pulmonary valve anomalies, as well as pulmonary valve commissural fusion, are seldom identified preoperatively on echocardiography. In this study, we report on 5 children with different types of pulmonary valve malformations diagnosed by transthoracic echocardiography.     

成人经皮球囊肺动脉瓣成形术的临床应用

目的：评价成人经皮球囊肺动脉瓣成形术（ＰＢＰＶ）临床应用的疗效。方法：采用 ＰＢＰＶ对 ３７例成人先天性肺动脉瓣狭窄患者进行治疗。结果：ＰＢＰＶ后即刻肺动脉瓣跨瓣压差（△Ｐ）由术前８１±２６ｍｍＨｇ降至３６±１７ｍｍＨｇ（Ｐ＜０．０１）,３２例随访１～９年,平均４．３±２．１年,△Ｐ进一步降为２５±７ｍｍＨｇ。术中及术后无严重并发症。结论：ＰＢＰＶ治疗成人肺动脉瓣狭窄安全、有效,即刻与中远期效果均良好。     

About mechanisms of prostaglandin E1 induced deterioration of pulmonary gas exchange in COPD patients

Summary. Prostaglandin E₁ (PGE₁) has been reported to attenuate COPD-related pulmonary hypertension and to slightly lower the arterial oxygen tension (PaO₂). In order to infer the involved mechanisms, the effects of intravenous infusion of PGE₁ on pulmonary haemodynamics, diffusing lung capacity for CO (DLCO), membrane diffusing capacity (Dm), pulmonary capillary blood volume (Vc), physiological shunt (Q_ps/Q_t), arterial blood gases and other lung functional indices were evaluated in 20 COPD patients with pulmonary hypertension and, excluding right catheterization, in 14 control subjects. The examines were studied at baseline and during infusion of 20–30 ng kg^-1min PGE₁ or placebo. In control subjects PGE₁ only caused systemic arterial pressure decrease (-17.8%). In COPD patients, as expected, PGE₁ increased cardiac index (16-2%), but decreased systemic arterial pressure (-21.2%), pulmonary arterial pressure (-27.9%), pulmonary vascular resistance (-45.4%) and PaO₂ (-10.4%), worsening their hypoxaemia. However, the effect of PGE₁ on DLCO was an increase (11.9%), due to an increase in Vc (15.2%) and less markedly in Dm (4.9%). Physiological and anatomical shunts were increased with PGE₁ (20.2% and 14.8%) and the overall ventilation/perfusion ratio decreased from 0.89 to 0.79. Decrements in PaO₂ correlated with increments in Q_ps/Q_t (r= 0.86). In conclusion, in COPD patients studied, PGE₁ increased DLCO, which compensated for the deleterious effect of increased cardiac output on alveolar-capillary gas equilibration. Therefore, worsening of hypoxaemia during PGE₁ infusion was related with increased right-to-left shunt and deterioration of ventilation-perfusion relationship.,     

Flash Pulmonary Edema in Multiple Sclerosis

Background

Neurogenic pulmonary edema (NPE) occurs in the setting of an acute neurological insult and in the absence of a primary cardiopulmonary cause. No unifying theory on NPE pathogenesis exists. NPE triggered by a discrete neurological lesion is rare, but such cases offer valuable insight into NPE pathogenesis.

Objective

To describe an unusual and instructive case of NPE in multiple sclerosis.

Case Report

A young woman with multiple sclerosis presented to the Emergency Department in acute respiratory failure. She was cyanotic centrally, hypertensive, and tachycardic. The chest X-ray study suggested pulmonary edema. She required non-invasive mechanical ventilation for 12 h. Echocardiography revealed left ventricular hypokinesis. The asymmetrical pulmonary infiltrate raised the suspicion of pneumonia; she was given intravenous antibiotics. By 36 h, she had persistent dyspnea, paroxysmal tachycardia, nausea, and facial flushing; carcinoid syndrome was excluded. By 48 h, she had facial numbness and ataxia. Magnetic resonance imaging (MRI) revealed a demyelinating lesion at the rostromedial medulla. Her symptoms promptly resolved with intravenous steroids, as did the perilesional edema on follow-up MRI.

Conclusion

Life-threatening pulmonary edema can complicate medullary demyelination. Lack of awareness of this diagnostic possibility and an asymmetrical pulmonary infiltrate culminated in diagnostic delay in this case. The case provides clinico-radiological evidence of the pathogenic link between medullary lesions and NPE. The pathogenesis is likely to rely on lesion involvement of the nucleus tractus solitarius or its immediate pathways. Non-uniform vasoconstriction of the pulmonary arterial bed might account for the other peculiarity of this case: the asymmetrical pulmonary infiltrate. Timely diagnosis of NPE is essential because the condition is best managed by nullifying the “neurogenic” trigger.     

Pathogenesis and clinical features of chronic pulmonary aspergillosis – Is it possible to distinguish CNPA and CCPA clinically?

BackgroundThe pathogenesis of chronic pulmonary aspergillosis (CPA) including chronic necrotizing pulmonary aspergillosis (CNPA), chronic cavitary pulmonary aspergillosis (CCPA), and simple aspergilloma (SA) has been poorly investigated. We examined all types of CPA cases with histopathological evidence to clarify the differences in pathogenesis and clinical features.MethodWe searched for cases diagnosed as pulmonary aspergillosis by histopathological examination in Nagasaki University Hospital between 1964 and September 2010. All available clinical information including radiological findings were collected and analyzed.ResultWe found 7, 5, 8, and 7 cases of proven CNPA, probable CNPA, CCPA, and SA, respectively. The radiograph of proven and probable CNPA was initially infiltrates or nodules that progress to form cavities with or without aspergilloma, whereas the radiograph of CCPA showed pre-existed cavities and peri-cavitary infiltrates with or without aspergilloma. The patients with proven and probable CNPA exhibited not only respiratory symptoms but also systemic symptoms and malnutrition. Aspergillus fumigatus was the most frequently isolated Aspergillus species (n = 14), however, Aspergillus niger was the predominant isolated species in proven CNPA cases (n = 4).ConclusionOur data indicate that the cases with chronic infiltration, progressive cavitation, and subsequent aspergilloma formation should be diagnosed as CNPA, and the cases with pre-existed cavities showing peri-cavitary infiltrates with or without aspergilloma would mean CCPA. However, it may be difficult to distinguish the two subtypes if a series of adequate radiography films are not available. We propose the term “chronic progressive pulmonary aspergillosis (CPPA)” for the clinical syndrome including both CNPA and CCPA.     

大剂量富露施对特发性肺间质纤维化患者肺功能的影响

目的探讨大剂量富露施对特发性肺间质纤维化患者肺功能的影响。方法将特发性肺间质纤维化患者随机分为两组,A组24例,每天口服强的松0·5mg/kg,4周后减半维持,同时口服富露施600mg/次,每天3次;B组24例,每天口服强的松0·5mg/kg,4周后减半维持。疗程均为3个月。观察临床表现、肺CT、血气、肺功能改变及症状缓解时间。结果A组患者的临床表现如气短、干咳、Velcro罗音经治疗后缓解率为66·7%,B组的缓解率为37·5%(P<0·05);A组缓解时间为(16·7±4·69)d,B组为(23·7±4·87)d(P<0·05);肺CT改善率在A组为62·5%,B组为29·2%(P<0·05)。A组患者治疗前后氧分压(PaO2)、百分肺活量(VC%)、一氧化碳弥散量(DLCO%)提高(P<0·05)。B组患者治疗前后PaO2、VC%、DLCO%有所提高,但与治疗前比较无显著性差异(P>0·05)。两组治疗后比较有显著性差异(P<0·05)。结论大剂量富露施能有效改善特发性肺间质纤维化患者的肺功能。     

造血干细胞移植后侵袭性肺曲霉病患者12例的肺功能改变

目的观察12例造血干细胞移植(HSCT)后并发侵袭性肺曲霉病(IPA)对患者肺功能参数及动脉血气的影响。方法 2007年2月~2009年10月本院接受HSCT后并发IPA患者12例,男8例,女4例,中位年龄34岁(26~67岁)。移植前后均行肺功能测试、动脉血气分析以及影像学检查。结果中位随访时间为132 d(97~432 d),无1例发生Ⅲ、Ⅳ度急性移植物抗宿主病(GVHD)。2例在移植1年后发生慢性GVHD。12例均为病理确诊或临床诊断IPA者,移植前肺功能测定仅有弥散功能轻度减退。抗真菌治疗8周后肺功能测试发现所有患者均存在不同程度的阻塞性通气障碍,其中8例患者呈小气道病变[FEF50和FEF75分别为(55.9±3.4)%和(41.9±4.1)%],4例患者则出现混合性通气障碍,总弥散量(DLCO)也显著降低[(47.4±2.9)%预计值],动脉血氧分压(PaO2)仅为(68.7±4.1)mmHg,但弥散常数(DLCO/VA)尚正常,与移植前无显著差异(P0.05)。结论 HSCT后并发IPA可对患者的肺功能造成不同程度的损害,肺内多部位感染或反复发生IPA的患者可出现较严重的混合性通气障碍,弥散也显著减退。